Subacute combined degeneration of the Spinal cord Flashcards
What is subacute combined degeneration of the spinal cord?
A neurological complication of vitamin B12 deficiency
What does Subacute combined degeneration of the spinal cord cause?
Degeneration of both the dorsal columns and corticospinal tracts
What is usually preserved in someone with Subacute combined degeneration of the spinal cord?
Pain and temperature
What are the possible presenting features of Subacute combined degeneration of the spinal cord?
Symmetrical distal sensory symptoms- begin in the feet and spread to the hands
Varying degrees of ataxia
Diminished vibration sense and proprioception in the legs
Limb reflexes may be exaggerated or diminished or absent (can present with mixed Upper and Lower Motor Neuron signs)
Autonomic bladder or bowel symptoms
What symptoms can present from dorsal colum involvement with Subacute combined degeneration of the spinal cord?
Distal tingling/burning/sensory loss is symmetrical and tends to affect the legs more than the arms
Impaired proprioception and vibration sense
What symptoms can present from lateral corticospinal tract involvement in someone with Subacute combined degeneration of the spinal cord?
muscle weakness, hyperreflexia, and spasticity
upper motor neuron signs typically develop in the legs first
brisk knee reflexes
absent ankle jerks
extensor plantars
What symptoms can present wit lateral corticospinal tract involvement in someone with Subacute combined degeneration of the spinal cord?
Sensory ataxia → gait abnormalities
Positive Romberg’s sign
What investigations can be done in someone with Subacute combined degeneration of the Spinal cord?
B12, folate
MRI Spine
Nerve conduction studies
Why would you do a MRI spine in someone with Subacute combined degeneration of the Spinal cord?
To rule out cervical myelopathy
What would nerve condution studies show in someone with Subacute combined degeneration of the Spinal cord?
Predominantly axonal neuropathy
What is the management of someone presenting with subacute combind degeneration of the spinal cord?
B12 replacement- Hydroxocobalamin 1 mg IM on alternate days
